Healthcare Provider Details

I. General information

NPI: 1841154150
Provider Name (Legal Business Name): COASTAL DME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 SOUTHWOOD DR
PANAMA CITY FL
32405-4905
US

IV. Provider business mailing address

7113 LAGOON DR
PANAMA CITY BEACH FL
32408-5509
US

V. Phone/Fax

Practice location:
  • Phone: 850-481-1117
  • Fax: 850-373-4858
Mailing address:
  • Phone: 850-481-1117
  • Fax: 850-373-4858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JORDAN LANCE
Title or Position: CEO
Credential:
Phone: 850-481-1117